An independent group of 20 experts from around the globe, convened by the Harvard Global Health Institute (HGHI) and the London School of Hygiene & Tropical Medicine, has issued a hard-hitting analysis of the global response to the 2014-15 Ebola outbreak in West Africa, published in The Lancet.

The report offers 10 major reform proposals to prevent future such catastrophes, with emphasis on: preventing major disease outbreaks; responding to outbreaks; the production and sharing of research data, knowledge, and technologies; and ways to improve the governance of the global health system, with a focus on the World Health Organization (WHO).

The members of the Harvard Global Health Institute-London School of Hygiene & Tropical Medicine Independent Panel on the Global Response to Ebola concluded that while the 2014-15 Ebola outbreak "engendered acts of outstanding courage and solidarity," it also caused "immense human suffering, fear and chaos, largely unchecked by high level political leadership or reliable and rapid institutional responses." Panel members come from academic institutions, think tanks and civil society, with expertise in Ebola, disease outbreaks, public and global health, international law, development and humanitarian assistance, and national and global governance.

The Panel is chaired by Professor Peter Piot, Director of the London School of Hygiene & Tropical Medicine and co-discoverer of the Ebola virus. Professor Piot said: "We need to strengthen core capacities in all countries to detect, report and respond rapidly to small outbreaks, in order to prevent them from becoming large-scale emergencies. Major reform of national and global systems to respond to epidemics are not only feasible, but also essential so that we do not witness such depths of suffering, death and social and economic havoc in future epidemics. The AIDS pandemic put global health on the world's agenda. The Ebola crisis in West Africa should now be an equal game changer for how the world prevents and responds to epidemics."

In addition to over 11,000 deaths from Ebola, the epidemic "brought national health systems to a halt, rolled back hard-won social and economic gains in a region recovering from civil wars, sparked worldwide panic, and cost several billion dollars in short-term control efforts and economic losses."

"The most egregious failure was by WHO in the delay in sounding the alarm," said Ashish K. Jha, Director of the Harvard Global Health Institute, K.T. Li Professor of International Health at the Harvard T.H. Chan School of Public Health (Harvard Chan) and a professor of medicine at Harvard Medical School. "People at WHO were aware that there was an Ebola outbreak that was getting out of control by spring...and yet, it took until August to declare a public health emergency. The cost of the delay was enormous," said Jha.

The report's ten recommendations provide a roadmap to strengthen the global system for outbreak prevention and response:

1. Develop a global strategy to invest in, monitor and sustain national core capacities
2. Strengthen incentives for early reporting of outbreaks and science-based justifications for trade and travel restrictions
3. Create a unified WHO Center with clear responsibility, adequate capacity, and strong lines of accountability for outbreak response
4. Broaden responsibility for emergency declarations to a transparent, politically-protected Standing Emergency Committee
5. Institutionalise accountability through an independent commission for disease outbreak prevention and response
6. Develop a framework of rules to enable, govern and ensure access to the benefits of research
7. Establish a global fund to finance, accelerate and prioritise R&D
8. Sustain high-level political attention through a Global Health Committee of the Security Council
9. A new deal for a more focused, appropriately-financed WHO
10. Good governance of WHO through decisive, timebound reform and assertive leadership

The Harvard and London School of Hygiene & Tropical Medicine teams felt strongly that an independent analysis from academic and civil society voices should inform the public debate, in addition to other planned official reviews of the global response.

According to Liberian Panel member Mosoka Fallah, Ph.D., MPH, of Action Contre La Faim International (ACF). "The human misery and deaths from the Ebola epidemic in West Africa demand a team of independent thinkers to serve as a mirror of reflection on how and why the global response to the greatest Ebola calamity in human history was late, feeble and uncoordinated. The threats of infectious disease anywhere is the threat of infectious disease everywhere," Fallah said. "The world has become one big village."

"We gathered world-class experts and asked, how can we bolster the dangerously fragile global system for outbreak response?" said the Panel's Study Director, Suerie Moon, MPA, PhD of the Harvard T.H. Chan School of Public Health and Harvard Kennedy School. "Now, the billion-dollar question is whether political leaders will demand the difficult but necessary reforms needed before the next pandemic. In other words, will Ebola change the game?"

"There is a high risk that we will fail to learn our lessons," said the Harvard Global Health Institute's Ashish Jha. "We've had big outbreaks before and even careful reviews after, but often the world gets distracted. We owe it to the more than 11,000 people who died in West Africa to see that that doesn't happen this time."

source: http://www.newshour.com.bd

A packet of cigarettes would cost more than $40 by 2020 under the tax plan released by federal Labor Party today.

The Labor Party argues that increasing the tobacco tax would conform with World Health Organisation recommendations about smokers paying for their habit.

Labor's shadow Health Minister, Catherine King, told Tom Iggulden, it would also mean a healthier budget.

CATHERINE KING: It's estimated it will raise $3.8 billion over the forward estimates, but of course this is a very important step in increasing our efforts to reduce tobacco consumption in this country.

We currently have some 2.5 million people who are still smoking and smoking kills around 15,000 people every year. We know the last time that we had a concerted effort both through excise raises but also through preventative health measures, plain packaging, advertising and putting medications onto the pharmaceutical benefits schemes. We had a dramatic drop in smoking rates and we know we have to continue our efforts if we are going to continue to get those rates down.

TOM IGGULDEN: Labor has been arguing against a potential increase in the GST saying it would hit people on the lower income scale the hardest. Isn't it true that those still left smoking are mostly at that lower income scale. Wouldn't you be hitting the poorest with this idea?

CATHERINE KING: Here's a huge contrast, here you've got the Government wanting to tax fresh food and health services - the things that actually keep us well. What Labor wants to do is try and look at reform with purpose, make sure that we actually with our taxation system are doing things that are productive.

Trying to get reduced smoking rates particularly amongst people who are the poorest in our community, the people who experience higher rates of cardiovascular disease, higher earlier death, who have the higher rates of smoking related cancers, people who experience stroke, trying to assist people in the income brackets to reduce their smoking is actually really important.

TOM IGGULDEN: Do you accept though that this still is a regressive tax, it does still hit people who don't have the disposable income to make other choices?

CATHERINE KING: The purpose of the tax is actually to reduce smoking rates. We know that the World Health Organisation is recommending that you go to a higher rate of excise and you keep ramping up your excise over time and our national tobacco strategy actually says that.

I absolutely acknowledge that people who are on lower incomes who continue to smoke, that this will be a big measure for them, but the measure is designed to try and encourage as many people as we can to stop smoking. We will have some announcements to make about targeted smoking cessation programs to try and help people.

ELEANOR HALL: That's Labor's health spokeswoman Catherine King speaking with Tom Iggulden.

source: http://www.abc.net.au/

Today, if you get a bacterial infection – even a serious one that lands you in a hospital bed – you probably feel confident an antibiotic will cure you.

My parents lived in a different world. When I was three years old, I became seriously ill with tuberculosis. I can only imagine their anguish. I had to be hospitalised for a full year, and I would probably have died were it not for the availability of a new form of treatment that combined three antibiotics. I was one of the first people in Europe to receive it.

The advent of antibiotics introduced a new era in medicine. But now, I fear we are moving backwards – to the world in which my parents lived, when bacterial infections were often lethal because there were no specific treatments available.

Many such infections are rapidly becoming resistant to life-saving drugs. This development can be attributed, to some extent, to biology. It is inevitable that each drug will lose its ability to kill disease-causing bacteria over time. That is because bacteria, through natural selection and genetic adaptation, become resistant to antibiotics.

However, we are speeding up the process dramatically by using antibiotics too much and often in the wrong contexts. We need to slow down the development and spread of resistance so that the antibiotics we have continue to work for as long as possible. We also urgently need to devote more resources to the research and development of new antibiotics.

Here is the prescription for action from the World Health Organisation (WHO).

Doctors, nurses, veterinarians and other health workers
Don't prescribe or dispense antibiotics unless they are truly necessary and you have made all efforts to test and confirm which antibiotic your human patient or the animal you are treating should have. Today, it is estimated that in half of all cases, antibiotics are prescribed for conditions caused by viruses, where they do no good. You can also do more to prevent infections in the first place by ensuring your hands, instruments and environment are clean, and employing vaccines where appropriate.

People using healthcare
Take antibiotics only when prescribed by a certified health professional, but also don't be timid about asking if you feel you really need them. If you take an antibiotic, always complete the full prescription, even if you feel better, because stopping treatment early promotes the growth of drug-resistant bacteria.

Farmers and others in the agriculture sector
Ensure that antibiotics given to animals are used only to control or treat infectious diseases and under veterinary supervision. Misuse of antibiotics in livestock, aquaculture and crops is a key factor contributing to antibiotic resistance and its spread into the environment, food chain and humans. Clean and uncrowded conditions and vaccination of animals can reduce the need to use antibiotics.

Governments
We need robust national action plans to tackle antibiotic resistance. Critical steps are improved surveillance of antibiotic-resistant infections, regulation of the appropriate use of quality medicines, and education about the dangers of overuse.

Development organisations
Compared with populations in industrialised nations, people in low-income countries are not getting fair access to antibiotics. Countries seeking donor help to strengthen their health systems need guidance to ensure essential antibiotics are affordable, reach the people who really need them, and are used responsibly.

Industry
Industry needs to move faster and more aggressively to research and develop new antibiotics, but we also have to implement new ways of stimulating research and development. Many talk of an antibiotic "discovery void" since the late 1980s. We are currently in a race between drug development and bacterial evolution.

Incentives for developing new antibiotics can help. There are some encouraging trends.

For example, the EU, the UK, the US and Canada have moved forward on projects to fill this knowledge gap by directly funding basic and clinical research by scientists; working with pharmaceutical companies; and offering monetary prizes for new diagnostics needed to use antibiotics more responsibly.

But it is clear that a new, more global approach is needed. The WHO global action plan on antimicrobial resistance calls for the creation of new partnerships to foster the development of antibiotics. The WHO and the drugs for neglected diseases initiative are working on the creation of a global antibiotic research and development facility that will collaborate closely with the pharmaceutical industry, universities, civil society and health authorities worldwide. The partnership will also ensure that new drugs are affordable for all and embed the need for conservation of new antibiotics in the development process.

Without a novel system for using antibiotics, we will repeat failed historic efforts to capitalise on one of the greatest scientific discoveries the world has ever seen.

Time is running out.

Marc Sprenger is director of the World Health Organisation's secretariat for antimicrobial resistance

source: http://www.theguardian.com/

A recent survey conducted describes the misconceptions about antibiotic tolerance as a "global health crisis" was found to be all over the place.

With the effort to put an end to the threats posed by antibiotics tolerance, The World Health Organization has surveyed a number of 10,000 people across 12 countries as part of the CDC's "Get Smart About Antibiotics Week,"

Surprisingly, although 64 per cent of the respondents claimed that antibiotics can cure common cold and flu and 32 per cent have noted that an individual should stop taking antibiotics once they feel better, Dr. Holly Phillips, CBS News medical contributor have identified both information as unsubstantiated.

As stated by Dr.Phillips, antibiotics have no effect against the common cold and flu, since they're both viruses. He says that the chances of increasing the risk of your infection not being cleared out properly becomes higher when you stop taking your antibiotics rather than completing the prescribed course.

As per CBS News, the survey found that 76 per cent of the respondents have misunderstood the concept of "resistance". They had a notion that antibiotic resistance meant the body was becoming resistant where in fact it's actually the bacteria that becomes resistant.

Furthermore, as Dr. Phillips explains it, if a bacterium has been exposed with antibiotics on a regular basis, they tend to adapt to it and evolve until antibiotics can no longer kill them. Thus making them clever microorganisms.

Dr. Phillips believes that this phenomenon should be considered as a global issue because a deadly and contagious kind of bacteria, known as superbugs are now emerging and this kind of bacteria are also known to be resistant to all antibiotics.

Currently, authorities are now taking a large scale initiative on the use of antibiotics for livestock as it has been lately found that 80 per cent of antibiotics used across the world was generated from animal feed and/or water for growth promotion and prevention of disease. Just last month, Jerry Brown, Governor of California has also passed a legislation to limit the use.

source: http://www.foodworldnews.com/

Antibiotic resistance threatens to reverse gains in life expectancy and undermine surgical advances like joint replacements — and misconceptions about the problem may be making it worse, the World Health Organization warned on Monday.

A multi-country survey conducted by the WHO uncovered dismaying — and dangerous — misunderstandings about the problem, which arises when bacteria mutate into new strains that can withstand most or all the antibiotics in the modern medicine chest. Those bacteria, often dubbed "superbugs," can be deadly.

Concerted action is needed to stem the rising tide of resistance, the Geneva-based global health agency said. Without it, some procedures that are now routine in health care may be too risky to undertake, said Dr. Keiji Fukuda, the WHO's special representative for antimicrobial resistance.

"Antibiotics are really one of the miracles of the time that we live in. They are a global good. And they are also a global good that we cannot take for granted," Fukuda told reporters.

"By reducing the ability to handle infections, we are really talking about the ability to treat many chronic diseases — diseases like diabetes, like cancer. Patients who have these kinds of diseases are susceptible to infections. ... Consequently people are going to have infections for longer. More people are going to die. It's going to cost more.

"Resistant bacteria cause 23,000 deaths and more than 2 million illnesses in the US each year, according to the Centers for Disease Control and Prevention. A British report last year predicted the global death toll from superbugs could reach 10 million a year by 2050.

The WHO survey found people don't understand the problem. A third of survey respondents thought they should stop taking an antibiotic prescription when they start to feel better — a practice that helps to drive resistance, because bacteria that haven't been killed by the initial doses may multiply and mutate.

Overuse of antibiotics also spurs resistance, and the survey found more troubling news in that arena: Nearly two-thirds of respondents thought antibiotics were effective treatments for colds and the flu, even though those illnesses are caused by viruses — which are immune to the drugs. And one-quarter of respondents felt it was OK to take antibiotics that had been prescribed for someone else, as long as they were being used to treat the same illness.

Other questions revealed that respondents didn't understand how resistance works. Two-thirds thought people who take their drugs correctly are not at risk, and 44 percent felt that that resistance is only a problem for people who regularly take antibiotics. In fact, a person who has never taken antibiotics could be infected with a resistant strain of bacteria and so could a person who only takes the drugs as directed.

The way resistance plays out also eluded most people, with 76 percent believing it means antibiotics stop working for them because their bodies become resistant to the drugs. In fact, it's the bacteria that become resistant. They can then spread to infect other people.

The survey did suggest that people are open to potential solutions. Seventy-three percent of respondents said farmers should reduce the amounts of antibiotics used in food production. Agricultural use of antibiotics is enormous, exceeding human use many times over. The drugs are mostly used to promote growth of livestock, not to treat sick animals.

A few countries — Denmark and the Netherlands among them — have stopped using antibiotics as growth promoters, said WHO's director-general, Dr. Margaret Chan, who noted farmers are able to charge premium prices for their meat as a result.

Fukuda said the WHO hopes to see signs of progress over the next five to 10 years, with countries uniformly adopting good practices for the prescription and use of antibiotics. That should lead to a decline in the numbers of people hospitalized with and deaths caused by antibiotic resistant infections. But he cautioned there is tough slogging ahead.

"To turn this around in all parts of the world is going to take us decades. And it's not going to be a one-time action. We're going to have to sustain it. It's basically a race against the pathogens that we deal with," Fukuda said.

The survey was completed by more than 10,000 people in 12 countries. Two countries from each of the WHO's six regional divisions were selected to be surveyed. The United States was not among the countries selected.

source: http://www.statnews.com

Background

In 2008, an estimated 347 million people in the world had diabetes and the prevalence is growing, particularly in low- and middle-income countries.

In 2012, the disease was the direct cause of some 1.5 million deaths, with more than 80% of those occurring in low- and middle-income countries. WHO projects that diabetes will be the 7th leading cause of death by 2030.

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin, a hormone that regulates blood sugar, gives us the energy that we need to live. If it cannot get into the cells to be burned as energy, sugar builds up to harmful levels in the blood.

There are 2 main forms of the diabetes. People with type 1 diabetes typically make none of their own insulin and therefore require insulin injections to survive. People with type 2 diabetes, the form that comprises some 90% of cases, usually produce their own insulin, but not enough or they are unable to use it properly. People with type 2 diabetes are typically overweight and sedentary, 2 conditions that raise a person's insulin needs.

Over time, high blood sugar can seriously compromise every major organ system in the body, causing heart attacks, strokes, nerve damage, kidney failure, blindness, impotence and infections that can lead to amputations.

World Health Day 2016: Key messages

WHO is focusing the next World Health Day, on 7 April 2016, on diabetes because:

1. The diabetes epidemic is rapidly increasing in many countries, with the documented increase most dramatic in low- and middle-income countries.
2. A large proportion of diabetes cases are preventable. Simple lifestyle measures have been shown to be effective in preventing or delaying the onset of type 2 diabetes. Maintaining normal body weight, engaging in regular physical activity, and eating a healthy diet can reduce the risk of diabetes.
3. Diabetes is treatable. Diabetes can be controlled and managed to prevent complications. Increasing access to diagnosis, self-management education and affordable treatment are vital components of the response.
4. Efforts to prevent and treat diabetes will be important to achieve the global Sustainable Development Goal 3 target of reducing premature mortality from noncommunicable diseases (NCDs) by one-third by 2030. Many sectors of society have a role to play, including governments, employers, educators, manufacturers, civil society, private sector, the media and individuals themselves.

Goal of World Health Day 2016: Scale up prevention, strengthen care, and enhance surveillance

The main goals of the World Health Day 2016 campaign will be to:

1. Increase awareness about the rise in diabetes, and its staggering burden and consequences, in particular in low-and middle-income countries;
2. Trigger a set of specific, effective and affordable actions to tackle diabetes. These will include steps to prevent diabetes and diagnose, treat and care for people with diabetes; and
3. Launch the first Global report on diabetes, which will describe the burden and consequences of diabetes and advocate for stronger health systems to ensure improved surveillance, enhanced prevention, and more effective management of diabetes.

source: http://www.who.int

GENEVA (Reuters) - A massive trade pact between 12 Pacific rim countries could limit the availability of affordable medicines, the head of the World Health Organization said on Thursday, joining a heated debate on the impact of the deal.

Margaret Chan told a conference there were "some very serious concerns" about the Trans-Pacific Partnership (TPP), a central plank of U.S. President Barack Obama's trade policy which still needs to be ratified by member governments.

"If these agreements open trade yet close the door to affordable medicines we have to ask the question: is this really progress at all," Chan asked a conference in Geneva.

The deal's backers, including the United States, Canada, Japan and Australia, say it will cut trade barriers and set common standards across 40 percent of the world's economy.

But other bodies, including leaders of India's $15 billion pharmaceuticals industry, have said it could end up protecting the patents of powerful drugs companies inside the deal area, at the expense of makers of cheaper generic drugs outside.

"Can you bear the cost of $1,000 for a pill to treat Hepatitis C?," Chan asked the audience of health experts, academics and diplomats. "Unless we get these prices down many millions of people will be left behind."

She said no country in the WHO objected to the private sector making a fair profit, but she was worried about companies influencing decision-making in health policy.

"I worry about interference by powerful economic operators in the new targets for alcohol, tobacco and non-communicable diseases, including many that are diet-related. Economic power readily translates into political power."

Chan said it was important to find the right balance between encouraging innovation and keeping drugs affordable, but some recent innovations had led to "astronomical" price rises.

U.S. unions, lawmakers and interest groups last week also raised concerns over the text of the deal, setting up a potentially difficult path to ratification by the United States, the biggest of the 12 partners.

U.S. labor representatives said the agreement contained weak, poorly worded or unenforceable provisions.

If ratified, the TPP will be a legacy-defining achievement for Obama and his administration's pivot to Asia, aimed at countering China's rising economic and political influence.

source: http://www.medicaldaily.com/

The Sustainable Development Goals have donors, implementers and civil society organizations looking to the future and asking: what's possible, what's measurable and what's next?

But in the run-up to the 2015 Paris Climate Conference, also known as COP21, and the release of the SDG indicators in March 2016, fewer stakeholders are using the SDGs as an opportunity to look back.

The U.S. Centers for Disease Control and Prevention announced Monday Sierra Leone will be declared Ebola-free if no new cases are discovered by Nov. 7. The West African country had more than 14,000 diagnosed Ebola cases, the largest number of confirmed cases in the outbreak that has killed more than 11,000 people since Jan. 2014.

"Lessons learned" have so far focused on operational reasons why health systems faltered and why the humanitarian response came late, often taking donors and international aid agencies like the World Health Organization to task for mishandling the crisis.

But a recent report released by the Overseas Development Institute offers a look at the systemic causes behind one of the deadliest disease outbreaks of the century, and why Ebola will be a wake-up call for the global health community.

Marc DuBois, former executive director of Médecins Sans Frontières, now an independent consultant and a co-author of the report, spoke with Devex about its findings and how the crisis should shape the world's approach to disaster risk reduction and building health systems.

The report claims the Millennium Development Goals may have displaced other strides to improve health systems in the most-affected countries. What lessons should we learn from this for the SDGs?

There seems to be widespread agreement that as a matter of first priority, people in countries like Guinea, Sierra Leone and Liberia required and still require functioning health care systems. The degree to which the very complex, setback-ridden, long-term goal of building a health care system does not mesh well with an aid system increasingly focused on quantifiable, short-term, "sexy" targets.

[Individual] projects and [silos of success] do not [add up to] a [health] system, and development work often seems to avoid complexity. The question is how to ensure that the SDGs will not reinforce piecemeal, project-based action that fits more easily into our highly modulated and segmented aid architecture.

The lesson from the MDGs would be the need for a much deeper understanding of the interrelationship between an MDG/SDG approach and an approach focused less on components and projects and more on overarching systems. That is not to imply that the two are mutually exclusive.

Can you explain the criteria for labeling a health crisis, as opposed to an humanitarian crisis? Are these hard-and-fast distinctions and if not, should they be? How does this play into criticisms of the World Health Organization and how it handled the response?

There is no criteria that would set such definitions, and there is both overlap and a circularity in terms of causation. Humanitarian catastrophe often provokes a health crisis, [for example] cholera or measles outbreak in an [internally displaced persons] camp, while the reverse is also true, [like with] Ebola in West Africa.

A major health crisis may not entail much of a humanitarian crisis if it can be managed, such as with severe acute respiratory syndrome, also known as SARS, or it may constitute a humanitarian crisis in and of itself, such as the meningitis outbreak across parts of West Africa a few years ago.

I don't think [the distinction] is particularly accurate — too subjective — or helpful. It is probably more useful to think in terms of the needs of the people.

In the early stages of the Ebola crisis, the people needed a response focused on health, and hence the logic of a WHO or local ministry of health taking the lead. But once Ebola had spread, it triggered a multisectoral crisis, with devastating effects on education, agriculture, livelihoods, security, protection, water and sanitation and non-Ebola health. At that stage, it should be evident that the mechanism for coordinating the response requires a more diverse set of skills and expertise, much more similar to the [United Nations Office for the Coordination of Humanitarian Affairs]-led cluster system found in many complex emergencies.

In terms of coming up with SDG indicators in March, and metrics for measuring the growth of health systems, what's the challenge? What's the most difficult to measure? And what's been discovered in the Ebola recovery effort about how to facilitate a better response — both from the get-go and after the fact?

The problem starts with the idea that you can measure the growth of health systems. Of course, one can measure many components of a health system, such as numbers of clinics, or staff, or the availability of key drugs. This is known as hard capacity, and it has become the bread and butter of the aid business.

But this focus on hard capacity can lead to two key concerns raised in our report: First, a system is larger than the sum of its parts — all of this tangible stuff that is delivered through aid projects does not necessarily aggregate upwards into a system. Second, certain "vital" system components defy measurement, such as the degree to which a health system depends on legitimacy of government and on relationships between people.

There is nothing wrong with building clinics or training staff per se, but there is a risk if those activities are expected to add up — presto! — to a health system, or if they become the sole focus of development efforts.

source: https://www.devex.com/